Developing a website to help women aged 55 + incorporate risk in decision-making about breast cancer screening and prevention medications

Mara A Schonberg; Jessica Jushchyshyn; Ria Shah; Long Ngo; Emily A Wolfson

doi:10.1016/j.pec.2025.108819

Developing a website to help women aged 55 + incorporate risk in decision-making about breast cancer screening and prevention medications

Patient Educ Couns. 2025 Aug:137:108819. doi: 10.1016/j.pec.2025.108819. Epub 2025 May 6.

Authors

Mara A Schonberg¹, Jessica Jushchyshyn², Ria Shah³, Long Ngo⁴, Emily A Wolfson⁵

Affiliations

¹ Department of Medicine, Beth Israel Deaconess Medical Center, 1309 Beacon, Brookline, MA 02446, USA. Electronic address: mschonbe@bidmc.harvard.edu.
² Department of Medicine, Beth Israel Deaconess Medical Center, 1309 Beacon, Brookline, MA 02446, USA. Electronic address: jjushchy@bidmc.harvard.edu.
³ Department of Medicine, Beth Israel Deaconess Medical Center, 1309 Beacon, Brookline, MA 02446, USA. Electronic address: ria_shah@icloud.com.
⁴ Department of Medicine, Beth Israel Deaconess Medical Center, 1309 Beacon, Brookline, MA 02446, USA. Electronic address: lngo@bidmc.harvard.edu.
⁵ Department of Medicine, Beth Israel Deaconess Medical Center, 1309 Beacon, Brookline, MA 02446, USA. Electronic address: ewolfson@bidmc.harvard.edu.

PMID: 40344909
PMCID: PMC12148690 (available on 2026-08-01)
DOI: 10.1016/j.pec.2025.108819

Abstract

Objectives: Guidelines recommend women consider their breast cancer risk and life expectancy when deciding on breast cancer screening (e.g., intervals, when to stop) and prevention medication. We previously developed a competing-risk model to predict 10-year breast cancer risk and non-breast cancer death in women > 55 years to support decision-making. Here, we aimed to develop a decision aid (DA) website incorporating our model's risk estimates.

Methods: We designed the DA based on international standards using the free R package Shiny. We included a risk-assessment page, risk estimates, and decision support on breast cancer screening and prevention medications. We recruited national experts, Boston-area primary care practitioners (PCPs), and female patients > 55 years without breast cancer history to provide feedback on the DA via questionnaire or personal interview. We used thematic analysis to identify themes in participants' open-ended comments until reaching thematic saturation. Study questionnaires assessed DA helpfulness and ease-of-use.

Results: Forty-five (53.6 %) of 84 eligible patients approached participated. Their mean age was 65.9 years (SD 7.9), 31 (68.9 %) were non-Hispanic White, and 31 (68.9 %) graduated college. Of 52 experts/PCPs contacted, 30 participated. Participants found the DA helpful (35/44 patients [79.5 %] and 28/29 [96.6 %] experts/PCPs) and easy-to-use (39/45 patients [86.7 %] and 28/29 PCPs/experts, [96.6 %]). They described the DA as "informative" and liked the "tailored-risk information." They suggested changes to simplify the DA and to better individualize the decision-support. We iteratively revised the website. We could not program some recommended changes using the free R application.

Conclusions: We developed an informative and easy-to-use breast cancer screening and prevention medication DA website (https://bcrisk55plus.shinyapps.io/risktool/) for women > 55 using free software. Next, we will program the website using HTML code and test its effects prospectively.

Practice implications: We anticipate that use of the DA will help women > 55 with breast cancer screening and prevention decisions.

Keywords: Decision-making; Mammography screening; Risk assessment.

MeSH terms

Aged
Breast Neoplasms* / diagnosis
Breast Neoplasms* / prevention & control
Decision Making*
Decision Support Techniques*
Early Detection of Cancer*
Female
Humans
Internet*
Mass Screening
Middle Aged
Risk Assessment
Surveys and Questionnaires

Abstract

MeSH terms

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